Association Between Anterior Cingulate Cortex Neurochemical Profile and Clinical Remission After Electroconvulsive Treatment in Major Depressive Disorder: A Longitudinal 1H Magnetic Resonance Spectroscopy Study.

BACKGROUND: The aim of the study was to assess anterior cingulate cortex (ACC) neurochemical profile of patients with unipolar major depressive disorder (MDD) before and after electroconvulsive therapy (ECT) by using 1H magnetic resonance spectroscopy (1H-MRS). METHOD: Using 1H-MRS, the metabolite levels of choline, glutamate + glutamine (Glx), myo-inositol, N-acetylaspartate, and total creatine were measured in ACC before and after 4-week ECT. The Montgomery-Åsberg Depression Rating Scale (MADRS) was implemented by blind raters to evaluate the efficacy of the treatment. Electroconvulsive therapy-remitter (ER) and nonremitter groups were compared using the 1-way repeated measures analysis of variance. RESULTS: Thirty patients with unipolar MDD (aged 41.3 ± 10.0 years, 66.7% female) were included in the study. The ER group (n = 16, 53.3%) and NR group did not differ regarding baseline Global Assessment of Functioning and MADRS scores. At the end of 4-week ECT treatment, results did not suggest any significant difference for metabolite levels in ACC. When compared with the NR group, the ER group had higher baseline levels of Glx (8.8 ± 1.8 vs 6.3 ± 2.0, P = 0.005) and total creatine (5.3 ± 0.6 vs 4.7 ± 0.5, P = 0.010). In addition, elevated baseline Glx (r = -0.68, P = 0.002) was associated with lower MADRS scores at the end treatment. Finally, the change in Glx levels was correlated with change in MADRS scores after ECT (r = 0.47, P = 0.049). LIMITATIONS: Modest sample size and 1H-MRS at 1.5 Tesla are limitations of the study. CONCLUSIONS: Results suggested that Glx levels could be a predictor of remission. Studies with larger samples should explore neurochemical correlates of ECT in unipolar MDD.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety.

OBJECTIVES: Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures. METHODS: Dentists from two major dental health centres in Izmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program. RESULTS: Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging. CONCLUSION: Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

The role of small GTPase Rac1 in ionizing radiation-induced testicular damage.

PURPOSE: The main acute and late effects of ionizing radiation on living organisms are the formation of reactive oxygen species (ROS), apoptosis and DNA damage. Since the Rac1 molecule is a subunit of the NADPH oxidase enzyme, it is known to participate in the generation of ROS. The aim of this study was to investigate the role of Rac1 molecule in testicular damage induced by low (0.02 Gy), medium (0.1 Gy) and high (5 Gy) dose irradiation. MATERIAL AND METHOD: In this study, Wistar rats (except the control group) were received whole body X-ray irradiation. Testicular tissues were removed 2 hours, 24 hours and 7 days after radiation exposure. Testicular damage was examined by hematoxylin-eosin staining and Johnsen's score. Immunohistochemical staining and G-LISA method were used to determine Rac1 expression and activation. To evaluate the generation of ROS in the testicular tissues, intracellular ROS, superoxide dismutase (SOD) and malondialdehyde (MDA) levels were measured. RESULTS: Increases in testicular damage were detected in all radiation exposed groups in a dose- and time-dependent manner. Compared to the control group, Rac1 expression decreased in all irradiated groups, while Rac1 activation increased. In addition, intracellular ROS and MDA levels were increased and SOD activity levels decreased in the irradiated groups compared to the control group. CONCLUSION: Our findings suggest that Rac1 has a role in the increase of intracellular ROS and lipid peroxidation which led to an increase in radiation- induced testicular damage.

In vivo proton magnetic resonance spectroscopic examination of benzodiazepine action in humans.

In an examination of the effect of benzodiazepines on brain chemistry, 44 healthy controls underwent a short echo-time proton magnetic resonance spectroscopy ((1)H MRS) session after induced sedation with intravenous midazolam (0.03mg/kg) plus fentanyl (2µg/kg). The regions of interest were the anterior cingulate cortex, right basal ganglia, right frontal lobe, and right hippocampus. Twenty-five of these subjects underwent the second (1)H MRS session while awake. The measured (1)H MRS metabolites included N-acetyl-aspartate, creatine-containing compounds (PCr+Cr), choline-containing compounds, myo-inositol, and glutamate plus glutamine, which were quantified both as absolute values and metabolite/PCr+Cr ratios. The results were analyzed using independent group t tests and repeated measures analysis of variance (ANOVA, with alpha values set at 0.025 to minimize the risk of false-positive findings arising from multiple comparisons. No significant difference between subjects under midazolam plus fentanyl induced sedation and awake could be detected with unpaired analyses. Paired comparisons by ANOVA with repeated measures found that neither drug (midazolam plus fentanyl) nor the drug by time (interval between two scan times) interaction had a significant effect on the quantified metabolites. These findings encourage utilization of benzodiazepine-induced brief sedation during in vivo (1)H MRS experiments of the brain, and may help with elucidation of state-dependent neurochemical alterations during the course of bipolar and schizoaffective disorders.

LOCAL STUDY OF DIAGNOSTIC REFERENCE LEVELS FOR COMPUTED TOMOGRAPHY EXAMINATIONS OF ADULT PATIENTS IN IZMIR, TURKEY.

PURPOSE: This study aims to develop local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations carried out around Izmir, Turkey. METHODS: Five common CT examinations (head, neck, chest, abdomen-pelvis (AP), chest-abdomen-pelvis (CAP)) from four different radiology centres have been included in the study. CT dose index-volume (CTDIvol) and dose length product (DLP) values were recorded for 50 patients per exam in each centre. Third quartiles of CTDIvol and DLP values were determined as DRLs and compared with international findings. RESULTS: 51.3% of the patients were male and 48.7% were female, with a mean age of 57 (between 18 and 93). DRLs for CTDIvol were recorded as 70, 16, 15, 23 and 16 for head, neck, chest, AP and CAP examinations, respectively, while the corresponding DLPs were 1385, 604, 567, 998 and 1180 mGy.cm. CONCLUSION: Results are mostly comparable to the latest international data, except for the head examinations, which were observed to slightly exceed the DRLs established by other countries.

Effects of the Use of Automatic Tube Current Modulation on Patient Dose and Image Quality in Computed Tomography

Objectives: The frequency of abdominal computed tomography examinations is increasing, leading to a significant level of patient dose. This study aims to quantify and evaluate the effects of automatic tube current modulation (ATCM) technique on patient dose and image quality in contrast-enhanced biphasic abdominal examinations. Methods: Two different scan protocols, based on constant tube current and ATCM technique, were used on 64 patients who visited our radiology department periodically. For three patient groups with different patient size, results from two protocols were compared with respect to patient dose and image quality. Dosimetric evaluations were based on the Computed Tomography Dose Index, dose length product, and effective dose. For the comparison of image qualities between two protocols, Noise Index (NI) and Contrast to Noise Ratio (CNR) values were determined for each image. Additionally, the quality of each image was evaluated subjectively by an experienced radiologist, and the results were compared between the two protocols. Results: Dose reductions of 31% and 21% were achieved by the ATCM protocol in the arterial and portal phases, respectively. On the other hand, NI exhibited an increase between 9% and 46% for liver, fat and aorta. CNR values were observed to decrease between 5% and 19%. All images were evaluated by a radiologist, and no obstacle limiting a reliable diagnostic evaluation was found in any image obtained by either technique. Conclusion: These results showed that the ATCM technique reduces patient dose significantly while maintaining a certain level of image quality.

Size-specific dose estimates in chest, abdomen, and pelvis CT examinations of pediatric patients.

PURPOSE: Size-specific dose estimates (SSDEs) are the latest focus of interest among medical physicists studying radiation dose to the patient in computed tomography (CT). This study aims to make conversions from CTDIvol to SSDE and investigate the relationship between mean SSDE (SSDE) and central SSDE (SSDEcenter) values for pediatric patients of different age groups undergoing chest, abdomen, and pelvis scans. METHODS: In this retrospective study, we examined 105 consecutive pediatric CT exams of chest, abdomen, and pelvis (CAP) classified in 3 separate groups according to age: 0-5 years, 6-10 years, and 11-16 years. A MATLAB program was developed to determine SSDE values for each patient along 6 subregions: chest, abdomen, pelvis, chest and abdomen, abdomen and pelvis, and CAP. SSDE values derived over the slice at the center of each scan range (SSDEcenter) were also recorded. SSDE and corresponding SSDEcenter results were compared for each age group. RESULTS: Root mean square differences (RMSD) between SSDE and SSDEcenter values ranged between 0.13 mGy and 2.1 mGy through all groups and subregions, corresponding to 1.2% and 11%, respectively. CONCLUSION: In pediatric CT exams involving CAP region, CTDIvol and the water equivalent diameter at the middle of the scan range can be used to provide a reasonable estimate of mean SSDE with an RMSD of 11% at most.

THE ABSORPTION PROPERTIES OF LEAD-FREE GARMENTS FOR USE IN RADIATION PROTECTION.

In this study, the absorption capability and the weight of various radiation-shielding materials were evaluated, for applications as alternatives to lead garments. Toxicity, atomic number, density, K-edge absorption energy and availability of elements that can serve as an alternative to lead, including tin, antimony, bismuth and tungsten, were considered. The attenuation coefficients of these elements were determined using the XCOM software package, and these metals were mixed with polymers at 50, 70, 80 and 85 % mass ratios. It can be concluded that all of the new shielding materials used in the study can be used for a diagnostic range of X-rays. However, they were compared with the commercial lead garments in terms of weight and attenuation coefficient; the 85 % samples were lighter than a 0.5-mm lead garment and provided superior radiation protection, which demonstrates its potential for commercial applications.

Trait-related alterations of N-acetylaspartate in euthymic bipolar patients: A longitudinal proton magnetic resonance spectroscopy study.

BACKGROUND: Neurochemical changes are responsible for bipolar disorder (BD) pathophysiology. Despite current progress in BD research, mood- and trait-related alterations in BD continue to elicit further investigation. METHODS: In this study, we report a longitudinal proton magnetic resonance spectroscopy study evaluating dorsomedial prefrontal cortex (DMPFC) metabolites N-acetylaspartate (NAA), creatine plus phosphocreatine (total creatine [tCr]), phosphorylcholine plus glycerophosphocholine, myo-inositol, and glutamate plus glutamine levels of manic and euthymic adult BD type I patients (n=48) treated with standard antimanic medicines, compared to matching healthy controls (n=44). RESULTS: DMPFC NAA values and NAA/tCr ratio were significantly lower in euthymic BD patients when compared with healthy controls with similar levels of other metabolites in all groups, indicating a trait-related NAA abnormality in euthymic BD patients. LIMITATIONS: of our study include a relatively low (1.5T) magnetic resonance field strength and variable drugs administered to achieve euthymia despite the best efforts to standardize the open fashion treatment. CONCLUSIONS: Our study contributes to the integrating models of trait-related metabolite alterations observed in euthymia since NAA is considered as a marker of neuronal viability and mitochondrial energy metabolism. In light of supporting and conflicting results reported previously, future studies with longitudinal designs and larger patient groups are warranted to better define both state- and trait-related cerebral metabolic alterations associated with BD pathophysiology.

Antimanic Treatment With Tamoxifen Affects Brain Chemistry: A Double-Blind, Placebo-Controlled Proton Magnetic Resonance Spectroscopy Study.

BACKGROUND: The antimanic efficacy of a protein kinase C (PKC) inhibitor, tamoxifen, has been tested in several clinical trials, all reporting positive results. However, mechanisms underlying the observed clinical effects requires further confirmation through studies of biological markers. METHODS: We investigated the effect of tamoxifen versus placebo on brain metabolites via a proton (1H) magnetic resonance spectroscopy (MRS) study. Forty-eight adult bipolar I manic patients (mean Young Mania Rating Scale (YMRS) score of 37.8±5.8) were scanned at baseline and following 3 weeks of double-blind treatment. We hypothesized that manic symptom alleviation would improve the levels of markers associated with brain energy metabolism (creatine plus phosphocreatine [total creatine; tCr]) and neuronal viability (N-acetylaspartate [NAA]). RESULTS: The YMRS scores decreased from 38.6±4.5 to 20.0±11.1 in the tamoxifen group and increased from 37.0±6.8 to 43.1±7.8 in the placebo group (p<0.001). 1H MRS measurements revealed a 5.5±13.8% increase in the dorsomedial prefrontal cortex (DMPFC) tCr levels in the tamoxifen group and a 5.3±13.1% decrease in tCr in the placebo group (p=0.027). A significant correlation between the YMRS score change and tCr percent change was observed in the whole group (Spearman ρ=0.341, p=0.029). Both tCr and NAA levels in the responder group were increased by 9.4±15.2% and 6.1±11.7%, whereas levels in the non-responder group were decreased by 2.1±13.2% and 6.5±10.5%, respectively (p<0.05). CONCLUSIONS: Tamoxifen effectively treated mania while it also increased brain tCr levels, consistent with involvement of both excessive PKC activation and impaired brain energy metabolism in the development of bipolar mania. CLINICAL TRIAL REGISTRATION: Registry name: ClinicalTrials.gov URL: https://clinicaltrials.gov/ct2/show/NCT00411203?term=NCT00411203&rank=1 Registration number: NCT00411203.

Evaluation of awareness on radiation protection and knowledge about radiological examinations in healthcare professionals who use ionized radiation at work.

OBJECTIVE: In this study, we evaluated the knowledge and perception and mitigation of hazards involved in radiological examinations, focusing on healthcare personnel who are not in radiation-related occupations, but who use ionising radiation as a part of their work. METHODS: A questionnaire was applied to physicians, nurses, technicians and other staff working in different clinics that use radiation in their work, in order to evaluate their knowledge levels about ionizing radiation and their awareness about radiation doses resulting from radiological examinations. The statistical comparisons between the groups were analyzed with the Kruskal Wallis test using the SPSS program. RESULTS: Ninety two participants took part in the study. Their level of knowledge about ionizing radiation and doses in radiological examinations were found to be very weak. The number of correct answers of physicians, nurses, medical technicians and other personnel groups were 15.7±3.7, 13.0±4.0, 10.1±2.9 and 11.8±4.0, respectively. In the statistical comparison between the groups, the level of knowledge of physicians was found to be significantly higher than the level of the other groups (p=0.005). CONCLUSION: The present study demonstrated that general knowledge in relation to radiation, radiation protection, health risks and doses used for radiological applications are insufficient among health professions using with ionizing radiation in their work.